The survey found that the basic medical insurance for urban residents and the new rural cooperative medical system (hereinafter referred to as the "New Rural Cooperative Medical System") have not only increased management costs, reduced management efficiency, and brought a lot of inconvenience to urban and rural residents due to separate systems, separated management, and dispersed resources.

, and solidified the dual structure of urban and rural areas, which has caused serious obstacles and negative impacts on the realization of fairness and justice and the promotion of social harmony, highlighted by the "three disadvantages" and "three duplications."

"Three disadvantages": First, it is not conducive to reflecting social fairness.

The separation of urban and rural medical insurance systems forces residents to passively join the corresponding security system based on their household registration status, which strengthens the concept of urban and rural household registration, solidifies the dual social structure, and cannot well reflect the fairness of social insurance.

Second, it is not conducive to the flow of human resources.

With the rapid advancement of urbanization in our country, the flow of human resources between urban and rural areas is accelerating. The urban and rural medical insurance systems are not connected, information is not shared, and management is not unified. This makes it difficult to continue the medical insurance relationship and treatment of these mobile employees.

, it is particularly difficult to transfer and continue medical insurance relationships when migrant workers move between urban and rural areas.

Third, it is not conducive to the sustainable development of the medical insurance system.

The urban and rural medical insurance systems are managed and handled by different departments respectively. It is impossible to plan the long-term development of various insurance systems in a unified and scientific manner, and it is impossible to uniformly and scientifically evaluate the true performance of the system operation, which increases the system cost and causes a serious waste of social resources.

"Three duplications": First, residents participate in insurance repeatedly.

Currently, employee medical insurance and resident medical insurance are managed by the human resources and social security department, and the "new rural cooperative medical insurance" is managed by the health department. Due to the inconsistency in management methods and information systems, information cannot be shared completely, and there are competing participations in actual work.

The problem of protecting resources has led to the phenomenon of repeated participation of urban and rural residents in various places.

In particular, the problem of duplicate insurance coverage for migrant workers, employees of township enterprises, rural students studying in cities, and farmers whose land has been expropriated is very prominent.

After integrating medical insurance management resources in Tianjin, Chengdu, Xiamen, and Taizhou, through information system comparison, it was found that 450,000, 270,000, 80,000, and 200,000 people were repeatedly insured respectively; 110,000 urban residents in Qixia District, Nanjing were insured

Among them, 40,000 people also participated in the New Rural Cooperative Medical System.

The second is duplication of financial subsidies.

According to typical analysis and rough calculations in areas that have implemented unified urban and rural management, the proportion of duplicate insurance participants accounts for about 10% of the number of insured urban and rural residents.

Based on the per capita financial subsidy of 120 yuan for urban and rural insured residents this year, the government will repeatedly subsidize 12 billion yuan for about 100 million insured residents, which significantly increases the unreasonable burden on finance at all levels.

The third is to repeatedly establish handling agencies and information systems.

After more than ten years of hard work, the information system of urban medical insurance agencies has been basically perfected. If the new rural cooperative medical insurance system sets up another agency and information system, it will inevitably increase management costs, reduce management efficiency, and waste a lot of financial funds.

According to estimates by the finance bureaus of cities such as Xiamen, if the new rural cooperative medical information system is built based on the urban medical insurance information system, an additional investment of about 60 to 80 million yuan (excluding annual maintenance costs) will be required.

You can imagine what a huge expense it is across the country!

How to solve the "three disadvantages" and "three duplications" problems and achieve the comprehensive, coordinated and sustainable development of the basic medical security system?

The central government has pointed out the direction. The "Opinions on Deepening the Reform of the Medical and Health System" (Zhongfa [2009] No. 6) points out that it is necessary to "effectively integrate basic medical insurance management resources and gradually realize the unification of urban and rural basic medical insurance administrative management."

In order to implement the requirements of the central medical reform documents and completely solve the "three disadvantages" and "three duplications" problems, many places have already carried out active exploration.

For example: Guangdong Province began to explore urban and rural coordination of medical insurance in 2004, and is one of the fastest-moving provinces and cities in the country.

Among the 21 prefecture-level cities in the province, 10 cities, including Shenzhen, Zhuhai, and Dongguan, have begun exploring urban and rural coordination of medical insurance. Municipal governments such as Qingyuan, Yangjiang, and Meizhou have decided to hand over the new rural cooperative medical system to the social security department for unified management.

Fujian Province has clarified the functions of the Department of Human Resources and Social Security in coordinating urban and rural medical security work, and requires the new rural cooperative medical information system to rely on the employee medical insurance information system. The provincial government will allocate 2 million yuan of special funds every year to reward areas that carry out urban and rural coordinating medical insurance.

At present, Xiamen City and more than 20 counties including Shaowu and Shanghang have achieved coordinated urban and rural medical insurance.

The executive meeting of the Fuzhou Municipal Government decided to actively create conditions to transfer the new rural cooperative medical system to the social security department for management.

Wuxi, Zhenjiang, Suzhou, Changzhou, Taizhou and other cities in Jiangsu Province are actively exploring urban-rural co-ordination. Each city attaches great importance to system connection and has introduced transfer and continuation measures; it has also simultaneously improved the level of medical insurance co-ordination and improved the financial capacity of the fund.

Cities such as Chengdu, Leshan, and Guangyuan Cangxi in Sichuan Province have all actively explored urban and rural coordination of medical insurance.

According to statistics from relevant departments, the three provincial-level administrative regions of Tianjin, Chongqing and Ningxia, 21 prefecture-level cities and 103 counties (districts and cities) have fully implemented urban and rural coordination of medical insurance.

Except for the medical insurance for urban and rural residents in Jiaxing, Zhejiang and 33 counties (districts and cities) in these areas, which are managed by the health department (employee medical insurance is still managed by the social security department), the rest of the areas are managed by the social security department.